MEDICARE: DR. TIFFANY KONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12014492A	IN

General Provider Information

NPI Number	:	1386494425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY KONG DDS

Provider Business Mailing Address
First Line	:	191 W GORDON PIKE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4518
Country	:	US
Telephone Number	:	812-824-4444
Fax Number	:	812-473-7703

Provider Business Practice Location Address
First Line	:	191 W GORDON PIKE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4518
Country	:	US
Telephone Number	:	812-824-4444
Fax Number	:	812-473-7703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	02/05/2026

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Directions to “ DR. TIFFANY KONG DDS” Practice Location

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